Healthcare - Medical Coder II

must live within one of the fifteen preferred states.
monday to friday 8am-4:30pm (remote)
requires dual monitors and a docking station

Summary:

Serves as the primary resource for medical coding updates and information. Advises clients on coding issues, provides in-depth research on new or unusual procedures, and makes recommendations when appropriate. Provides support to the Claims and Provider Relations Departments.

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Essential Functions:

• Directly responsible and accountable for performing chart reviews, physician education, and maintaining comprehensive knowledge of coding rules and regulations.

• Provide overall coding expertise, as well as administrative and technical oversight, to ensure successful integration of Molina initiatives.

• Performs ongoing chart reviews and abstracts diagnosis codes.

• Develops an understanding of current billing practices in provider offices to ensure that diagnosis and CPT codes are submitted accordingly.

• Coordinates with Clinical Informatics on system errors and suggests improvements to ensure effective and efficient processes are followed.

• Documents results/findings from chart reviews and provides feedback to management, providers, and office staff.

• Creates necessary tools (educational materials, newsletters, etc.) for providers to assist them in current and accurate coding practices.

• Provides training and education to a network of providers on how to improve their risk adjustment knowledge, and delivers coding updates related to Risk Adjustment.

• Monitors provider progress to ensure guidelines set forth by CMS (Centers for Medicare and Medicaid Services) are being followed.

• Builds positive relationships between providers and Molina by providing coding assistance when necessary.

• Responsible for administrative duties such as planning and scheduling chart reviews, obtaining medical records, and coordinating provider training and education.

• Collaborates with cross-functional teams to support a variety of projects, such as implementation of risk adjustment applications and development of reports.

• Assists in coordinating management activities with other departments at Molina, including Finance, Revenue Analytics, Claims and Encounters, and Medical Directors.

• Supports CMS Data Validation activities, including record selection, tracking, and submission, in conjunction with the Coding Manager of the RAMP Department.

• Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, and participating in professional societies.

• Contributes to team efforts by accomplishing related results as needed.

• Other duties as assigned.

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Additional Coding Responsibilities:

• Reviews and researches billed unlisted procedure codes to determine if a more specific code exists.

• Supplies coverage and pricing information to the client Medical Director regarding unlisted codes.

• Conducts meetings with state clients to discuss procedure code coverage and ensures coding decisions are implemented.

• Responsible for archiving all Procedure Code Workgroup (PCW) agendas, minutes, and related materials.

• Maintains HIPAA reason and remark code lists and provides code updates to the HIPAA Code Workgroup when necessary.

• Supports the Claims Department by working edit reports as assigned.

• Provides Provider Relations with coding issues and updates to be shared with providers to ensure timely and accurate claim payment.

• Maintains a library of code books and relevant resources to be available to personnel when necessary.

• Serves as a resource for clients and co-workers with questions related to coding issues.

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Knowledge, Skills, and Abilities:

• Proficient in Microsoft Excel and MS Office Suite.

• Ability to work independently with minimal supervision.

• Excellent verbal and written communication skills.

• Ability to abide by Molina's policies.

• Maintains attendance to support required quality and quantity of work.

• Maintains confidentiality and complies with HIPAA regulations.

• Ability to establish and maintain positive and effective working relationships with coworkers, clients, members, providers, and customers.

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Education and Experience Requirements:

Required Education:
Associate’s Degree or equivalent combination of education and experience.
(Bachelor’s Degree preferred.)

Required Experience:

• 2+ years in a healthcare setting.

• 2+ years of experience in coding and medical record chart review.

• 2–4 years of professional or hospital coding experience.

• Knowledge of insurance claims processing.

Required Certification:
Active and unrestricted coding certification:

• CPC (Certified Professional Coder)

• CIC, CCS, RHIT, or RHIA also accepted